Articulated tool positioner for robotic surgery system

ABSTRACT

In some embodiments, an insertion device for a robotic surgery apparatus can include one or more guides configured to receive and/or engage a plurality of control links. The one or more guides can each include a plurality of channels. The insertion device can include a tool interface configured to engage one or more surgical tools for performing a surgical procedure. At least one control link of the first, second, or third pluralities of control links can be overlapping, coaxially aligned, or otherwise placed in a nested configuration with respect to another control link of the first, second, or third pluralities of control links. One or more of the plurality of first, second, or third control links can be configured to be actuated to adjust spatial position of the tool interface to facilitate repositioning of the surgical tool.

TECHNICAL FIELD

This disclosure relates generally to robotic surgical manipulators andarticulated tool positioners for performing a medical procedure.

DESCRIPTION OF RELATED ART

Articulated tool positioning devices are used to perform medical andsurgical procedures, such as laparoscopic surgery and computer assistedrobotic surgery, within a body cavity of a patient. An articulated toolpositioner generally includes a device to control insertion of avisualization devices and/or one or more instruments during the surgicalprocedure. Known articulating tool positioning systems suffer from avariety of shortcomings, including large size, poor resolution ofcurvature, lack of reliability, and the like. The present disclosureovercomes these and other problems associated with known articulatedtool positioning systems, methods, and apparatuses.

SUMMARY

In some cases, an insertion device for a robotic surgery apparatus caninclude one or more guides each comprising a plurality of channels. Theinsertion device can include a tool or instrument interface configuredto engage a surgical tool or instrument configured to perform roboticsurgery. The insertion device can include one or more pluralities ofcontrol links configured to be actuated to cause the one or more guidesto assume positions that selectively define a substantially continuouscurve.

The insertion device can include a first plurality of control links caneach comprise a first end portion configured to engage a second guide.One or more of the first plurality of control links can extend through arespective channel of a first guide.

The insertion device can include a second plurality of control links caneach comprise a first end portion configured to engage the first guideand a second end portion configured to engage a third guide. One or moreof the second plurality of control links can extend through a respectivechannel of the second guide.

The insertion device can include a third plurality of control links caneach comprise a first end portion configured to engage the toolinterface. One or more of the third plurality of control links canextend through respective channels of the third guide and can furtherextend through the respective channels of the second guide. One or more(e.g., each of) of the third plurality of control links can include aportion that passes through and/or is coaxially aligned with arespective second control link of the second plurality of control links.

One or more of the second plurality of control links can be configuredto cause the third guide to maintain an orientation generally the sameas the first guide when any of the first plurality of control links andthird plurality of control links is actuated.

One or more of the third plurality of control links can be configured tobe actuated to cause the tool interface to be selectively moved into anyof a plurality of orientations defining a substantially continuous curvefrom the third guide to the tool interface.

One or more of the first, second, and/or third pluralities of controllinks can be configured to be actuated to adjust spatial position of thetool interface to facilitate repositioning of the surgical tool.

The insertion device of any of preceding paragraphs and/or any ofinsertion devices described below can include one or more of thefollowing features. The insertion device can further comprise a supportcover configured to inhibit at least one of: displacement of one or moreof the first plurality of control links from the respective channel ofthe first guide, displacement of one or more of the second plurality ofcontrol links from the respective channel of the second guide, ordisplacement of one or more of the third plurality of control links fromthe respective channel of the second guide. The support cover caninclude an external sheath, a coil, or both such that the externalsheath covers the coil. One or more of the channels of the first guide,second guide, and/or third guide can be sized to receive a respectivecontrol link of any one of the first plurality of control links, thesecond plurality of control links, or the third plurality of controllinks. One or more of the first, second, and/or third pluralities ofcontrol links can include a hollow interior portion through which theportion of another one the first, second, and/or third pluralities ofcontrol links can pass. One or more of the first, second, and/or thirdpluralities of control links can include an external control linkdefining an internal pathway and an internal control link, such that atleast a portion of the internal control link can pass through theinternal pathway. The internal control link can be configured to bepulled to cause the tool interface to change position and/or to compressthe external control link. The internal control link can be pulled byone or more actuators. The external control link can be configured to becompressed (e.g., pushed) to cause the tool interface to change positionand/or to pull the internal control link. The external control link canbe compressed by one or more actuators. The insertion device can includeone or more intermediate guides. The one or more intermediate guides canbe positioned between and/or engaged with at least one of the firstguide, the second guide, the third guide, the tool interface, andanother intermediate guide. One or more of any one of the first, second,and/or third pluralities of control links can disposed in a parallelspaced apart relation through the respective channel of at least one ofthe first guide, the second guide, the third guide, and the toolinterface.

In some cases, a method of operating a robotic surgery apparatusincludes controlling at least one surgical instrument using an insertiondevice of any of preceding paragraphs and/or described below.

Any of the insertion devices and/or methods of any of precedingparagraphs and/or described below can be used with any of insertiondevices, methods, and/or robotic surgery systems described herein.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present disclosure will now be described hereinafter,by way of example only, with reference to the accompanying drawings inwhich:

FIGS. 1A-1B illustrate a robotic surgery system in accordance with someembodiments;

FIGS. 2-9 illustrate an insertion device in accordance with someembodiments;

FIGS. 10-12 illustrates a guide in accordance with some embodiments;

FIG. 13 illustrates coupled guides in accordance with some embodiments;

FIGS. 14-16 illustrate an insertion device in accordance with someembodiments;

FIGS. 17-18 illustrate guides in accordance with some embodiments; and

FIG. 19 illustrates an actuator in accordance with some embodiments.

DETAILED DESCRIPTION Overview

When performing medical procedures (for example, with assistance ofsurgery using a robotic surgical system) one or more instruments can beinserted into a body cavity of a patient. The insertion process has somerisk since instruments may inadvertently damage organs or tissue whilebeing inserted. Incorrect positioning of the one or more instruments inthe body cavity may also result in a limited range of motion within thebody cavity.

As an example, when performing general surgery in the abdominal region,at least one incision would be made in a body wall of the patient'sabdomen. A trocar or other access port, may then be inserted through theincision. An insertion device can be inserted through the access portand used by a surgeon to position and/or actuate one or more instrumentsto perform various task of a surgical site. Increased reliability whenpositioning the one or more instruments within the surgical sitefacilitate insertion of the one or more instruments and theirmanipulation of the surgical site.

Referring to FIG. 1A, a robotic surgery system in accordance with someembodiments is shown generally at 100. In some implementations, therobotic surgery system 100 can be configured to facilitate a medicalprocedure performed via a single incision. A single access port can beinserted into the incision to provide access for one or more instrumentsand cameras.

The system 100 can include a workstation 102 and a patient cart 104. Thepatient cart 104 can include a central unit or drive unit 106 to whichinstrument insertion and visualization devices 108 can be attached ormounted. The workstation 102 can include an input device 112 thatreceives operator (such as, a surgeon) input and produces input signalsand may also be configured to generate feedback to the operator. Thefeedback can be visual, auditory, haptic, or the like. The input device112 can be implemented using a haptic interface available from ForceDimension, of Switzerland, for example.

The workstation 102 can further include a master processor circuit 114in communication with the input device 112 for receiving the inputsignals and generating control signals for controlling the roboticsurgery system, which can be transmitted to/from the patient cart 104via an interface cable 116. In some cases, transmission can be wirelessand interface cable 116 may not be present. The input device 112 caninclude right and left hand controllers 122 and 124, which areconfigured to be grasped by the operator's hands and moved to produceinput signals at the input device 112. The patient cart 104 can includea slave processor circuit 118 that receives and the control signals fromthe master processor circuit 114 and produces slave control signalsoperable to control the instrument insertion and visualization devices108 and one or more instruments (and their respective end effectors)during a surgical procedure. The one or more instruments can includedexterous tools, such as grippers, needle drivers, staplers, dissectors,cutters, hooks, graspers, scissors, coagulators, irrigators, suctiondevices, that are used for performing a surgical procedure. While bothmaster and slave processor circuits are illustrated, in otherembodiments a single processor circuit may be used to perform bothmaster and slave functions. The workstation 102 can also include a userinterface, such as a display 120 in communication with the masterprocessor circuit 114 for displaying information (such as, body cavityimages) for a region or site of interest (for example, a surgical site,a body cavity, or the like) and other information to an operator. Theworkstation 102 can also include one or more controllers, such as one ormore pedals 126, for controlling the robotic surgery system. Forexample, one or more pedals 126 can include a clutch pedal that allowsrepositioning one or more controllers 122 or 124 without correspondingmovement of the associated instrument.

Referring to FIG. 1B, a surgical tool apparatus 140 can include anactuator housing 142 and an insertion channel configured to receive oneor more elongate insertion devices 200 extending outwardly from theactuator housing 142, as described in further detail herein. Theinsertion device 200 includes a plurality of control links, shown in thepartial cut-away on the insertion device 200. The plurality of controllinks (or connection or connectors) can extend along a length of theinsertion device 200 and are operable to cause movement of anarticulation section 204 of the insertion device 200 in response tomovement of the plurality of control links in an actuating direction.The actuating direction is generally aligned with the length of theinsertion device 200 and is indicated by the arrow 150.

In the embodiment shown, the insertion device 200 includes a housing 202and an articulation section 204 including a plurality guides, asdescribed herein. The plurality of guides are operable to move withrespect to each other in response to pushing and/or pulling of theplurality of control links causing one or more portions of thearticulation section 204 to assume various positions and orientations.

The surgical tool apparatus 140 can include a plurality of actuators130. In this embodiment, the plurality of actuators 130 for positioningthe articulation section 204 of the insertion device 200. In thisembodiment, each of the actuators 130 is associated with a respectivecontrol link of the plurality of control links and is mounted in theactuator housing 142 to facilitate a range of travel in a transversedirection. The transverse direction is substantially orthogonal to theactuating direction 150. In the embodiment shown, each actuator 130 isreceived on one of a plurality of adjacently located parallel railsconfigured to guide the respective actuators 130 for movement in thetransverse direction. The plurality of actuators 130 may include furtheractuators for controlling functions of the tool interface and/or asurgical tool, as described herein.

Each of the actuators 130, by travel along the transverse direction, areoperable to transmit compression and/or tension forces to a respectivecontrol link to actuate the control link and respective guides. In thesome instances, the plurality of actuators 130 and the associatedplurality of control links are configured to place the control links ofthe insertion device 200 in a relaxed condition when the actuators 130are disposed at a location within the actuator housing 142 that isoffset from a center of the range of travel of the actuator by adistance.

The surgical tool apparatus can be attached to the drive unit 106, suchas to the bottom of the drive unit. The drive unit 106 can include aninterface that mates with the plurality of actuators 130 and controlsthe plurality of actuators 130 in response to one or more commands orsignals from the workstation 102.

Additional details of controlling one or more of the actuators aresimilar to those described in U.S. Pat. No. 9,629,688, which areassigned to the assignee of the present application and the disclosureof which is incorporated by reference in its entirety.

Referring to FIGS. 2-5, in some cases, insertion devices 200 can includea housing 202 and an articulation section 204. The articulation section204 can be located in a distal direction from the housing 202 tofacilitate insertion of the articulation section 204 through anincision. The insertion device 200 can include a plurality of guides forguiding and/or engaging one or more control links within at least aportion of the articulation section 204. For example, the insertiondevice 200 can include a first guide 210, a second guide 230, and athird guide 250.

The insertion device 200 can include a tool interface 270 to which oneor more instruments of the system 100 can be removably (ornon-removably) attached. The tool interface 270 can include an openingin which the one or more instruments, such as tools used for performinga surgical procedure, can be positioned.

The insertion device 200, in various instances, can include one or moreintermediate guides. For example, one or more intermediate guides can bepositioned between the first guide 210 and the second guide 230;positioned between the second guide 230 and the third guide 250; and/orpositioned between the third guide 250 and the tool interface 270.

One or more of the first guide 210, the second guide 230, and the thirdguide 250 can include a plurality of passages, lumens, or channels forinserting, guiding, receiving, and/or engaging one or more controllinks. As described herein, the plurality of channels can be formedwithin the guide to permit insertion of a lumen, cable, coil, elongateshaft, tube, or control links. As is illustrated in FIG. 5, theinsertion device 200 can include a first plurality of control links 220,a second plurality of control links 240, and a third plurality ofcontrol links 260. One or more of the pluralities of control links 220,240, 260 can extend through and/or engage with one or more of the guides210, 230, 250, as described herein. At least one of the plurality ofcontrol links 220, 240, 260 can be coaxially aligned with and/or overlapat least a portion of any one of another of the pluralities of controllinks 220, 240, 260. A proximal end of one or more of the plurality ofcontrol links 220, 240, 260 can extend beyond the first guide 210 to beactuated by the drive unit 106 to adjust spatial position of one or moreof the first guide 210, the second guide 230, the third guide 250, andthe tool interface 270 to facilitate repositioning of the one or moreinstruments (e.g., a surgical tool).

At least a portion of the articulation section 204 can be overlaidand/or enclosed by a support cover. The support cover may inhibitunintentional displacement of one or more components of the articulationsection 204 and/or inhibit transfer of fluids into the articulationsection 204 from an outside environment. As illustrated in FIGS. 2-4,the support cover can include one or more of an external sheath 206 anda coil 208.

Guides

FIG. 5 illustrates a front perspective view of an insertion device 200,according to some embodiments. As described herein, the articulationsection 204 of the insertion device 200 can include a first guide 210, asecond guide 230, a third guide 250, and the tool interface 270. One ormore of the guides 210, 230, 250 and the tool interface 270 can beconfigured (for example, sized and/or shaped) to permit one or more ofthe pluralities of control links 220, 240, 260 to pass through and/orengage the guides 210, 230, 250 and/or the tool interface 270.

The insertion device 200 can include at least one intermediate guide290, disposed between any one of the first guide 210, the second guide230, the third guide 250, and the tool interface 270 and another one ofthe guides 210, 230, 250 or the tool interface 270. For example, withreference to FIG. 5, the insertion device 200 can include a plurality ofintermediate guides 290 disposed between the first guide 210 and thesecond guide 230. However, it will be understood by one having skill inthe art that any number of intermediate guides 290 may positionedbetween any of the guides 210, 230, 250 or the tool interface 270. Insome cases, the insertion device 200 comprises at least one of a firstintermediate guide 290 coupled to the first guide 210, a secondintermediate guide 290 coupled to the second guide 230, a thirdintermediate guide 290 coupled to the third guide 250, and a fourthintermediate guide 290 coupled to the tool interface 270. Each of theintermediate guides 290 can be coupled to an adjacent intermediate guide290, the first guide 210, the second guide 230, the third guide 250, orthe tool interface 270.

The intermediate guide(s) 290 can include the same or similar structureas the first guide 210, second guide 230, and/or third guide 250 suchthat the insertion device 200 comprises a plurality of generallycoaxially aligned components all having outer surfaces of the samecommon diameter. As described herein, at least some of the guides 210,230, 250, 290 can include one or more channels 236 that align withcorresponding one or more channels 236 in an adjacent guide 210, 230,250, 290 such that one or more control links are permitted to passthrough at least some of the guides 210, 230, 250, 290.

The guides 210, 230, 250, 290 can be coupled to another guide in amanner that permits bending of the articulation section 204 of theinsertion device 200. The articulation section 204 can bend (asdescribed herein) as a result of at least one of pulling or pushing oneor more control links positioned along the articulation section 204 thatcontrol, for example, the bend, curvature, or another aspect of spatialorientation of one or more of the first guide 210, the second guide 230,the third guide 250, and/or the tool interface 270.

As illustrated in FIGS. 6-9 that shows the first guide 210, the secondguide 230, the third guide 250, and the tool interface 270,respectively, the guides 210, 230, 250 and the tool interface 270 caninclude one or more channels 236 each configured to receive and/orengage one or more of the plurality of control links 220, 240, 260.Unless otherwise noted, the first guide 210, the second guide, the thirdguide 230 and/or an intermediate guide 290 can include components thatare the same as or generally similar to the components discussed hereinwith reference to the other guides 210, 230, 250, 290. For example, itwill be understood that the features described with reference to thesecond guide 230 shown as in FIGS. 10-12 can be generally the same orsimilar to any of the other structures described and/or contemplatedherein with reference to the first guide 210, the third guide 230,and/or an intermediate guide 290.

FIGS. 10-12 illustrate that, in certain cases, the guide (e.g., thesecond guide 230) can have a generally cylindrical base 232 and anaxially extending projection 234. The projection 234 of the second guide230 can have a cross-sectional diameter smaller than a cross-sectionaldiameter of the base 232 such that the projection 234 extends from thebase 232. The smaller cross-sectional diameter of the projection 234 canbe configured to interface with the base 232 of an adjacent guide, asdescribed herein. For example, the projection 234 can include atruncated spherical portion 235 through which a central opening 233 isformed. The central opening 233 extends axially through the projection234 and the base 232.

In some instances, as illustrated in FIG. 11, a proximally-facing endsurface of the base 232 includes a socket 238 configured to receive acorresponding projection 234 on an adjacent guide (e.g., an intermediateguide 290). Referring to FIG. 13, the truncated spherical portion 235and the socket 238 serve to couple a guide (e.g., the second guide 230)with another guide (e.g., the intermediate guide 290). For example, thesocket 238 can have a shape complementary to the truncated sphericalportion 235 on the projection 234 of an intermediate guide 290 toreceive that projection 234 therein. The projection 234 and the socket238 on the intermediate guide 290 allow the intermediate guide 290 topivot about the projection 234.

The projection 234 can be integral with the base 232, as illustrated inFIGS. 10-12. However, in some cases, the projection can comprise acomponent formed separately from the base 232. FIGS. 14-20 show that, incertain cases, an insertion device 300 may comprise a spacer 334positioned between respective guides (e.g., a second guide 330 and anintermediate guide 390). The spacer 334 can be configured to facilitateengagement and/or movement of a guide relative to an adjacent guide.FIGS. 14-20 are various views of an insertion device 300. It should beunderstood that, unless otherwise stated, similar reference numerals inFIGS. 14-20 refer to components that are the same as or generallysimilar to the components in other figures discussed herein with similarfeatures. It will be understood that the features described withreference to insertion device 300 shown in FIGS. 14-20 can be used withany of the embodiments described and/or contemplated herein. It willalso be understood that any feature, structure, material, step, orcomponent of any embodiment described and/or illustrated herein (e.g.,the insertion device 200) can be used with or instead of any otherfeature, structure, material, step, or component of any embodiment ofthe insertion device 300 shown in FIGS. 14-20.

FIGS. 17-18 illustrate that, in certain cases, an intermediate guide 390can have a generally cylindrical base 332. In some instances, one orboth of a proximally-facing end surface and a distally-facing endsurface of the base 332 can include a socket 338 configured to receive acorresponding spacer 334 (see FIG. 14) positioned between a firstintermediate guide 390 and a second intermediate guide 390. The spacer334 can include a truncated spherical portion on a proximally-facingsurface and/or a distally-facing surface of the spacer 334. Thetruncated spherical portion and the socket 338 serve to couple the firstintermediate guide 390 with another guide. For example, the socket 338can have a shape complementary to the truncated spherical portion on thespacer 334 to receive that spacer 334 therein. The spacer 334 and thesocket 338 on the intermediate guide 290 allow the intermediate guide290 to pivot about the spacer 334.

With reference again to FIGS. 5-13, the base 232 of the second guide 230can include a plurality of channels 236 each configured to receiveand/or engage with one or more of the plurality of control links 220,240, 260. The channels 236 may be formed to include an opening having awidth sized and shape to correspond with a respective control link suchthat the respective control link is permitted to pass through and/orengage the base 232.

The plurality of channels 236 can be positioned such one or more of theplurality of control links 220, 240, 260 are in a pre-defined spacedapart relation relative to each other. Generally, the individual controllinks of each plurality of control links 220, 240, 260 are spaced apartangularly on a circle relative to the other individual control links inthe same plurality of control links 220, 240, 260 such that the controllinks of a given plurality are spaced apart from each other as far aspossible. This reduces and balances actuation loads, increases thestiffness of the flexible section and reduces backlash effects as thedirection of force on the flexible control links is changed in responseto pushing and pulling of the control links.

One or more of the channels 236, in some instances, can include anengagement portion (e.g., a ridge 237) configured to reduce a width ofthe opening and to facilitate engagement of the base 232 with a controllink. The ridge 237 can be positioned along a surface of the channel236. As described in further detail herein, the second guide 230 caninclude one or more channels 236 configured permit the passage of one ormore control links through the second guide 230 and further include oneor more additional channels 236 each including an inner ridge 237configured to engage one or more other control links with the secondguide 230. The ridge 237 can permit attachment of the second guide 230to a control link (e.g., one or more of the first plurality of controllinks 210). For example, with reference to FIG. 7, the second guide 230may comprise eight channels including four channels 236 each comprisingan inner ridge 237 configured to engage the first plurality of controllinks 220 and an additional four channels configured to permit thepassage of the second plurality of control links 240 and the thirdplurality of control links 260 through the second guide 230, asdescribed in further detail herein. By way of another example, FIG. 6illustrates that the first guide 210 may comprise eight channelsincluding four channels 236 each comprising an inner ridge 237configured to engage the second plurality of control links 240, whilepermitting passage of the third plurality of control links 260 throughthe four channels 236, and including an additional four channelsconfigured to permit the passage of the first plurality of control links220 through the first guide 210, as described in further detail herein.By way of further example, FIG. 8 illustrates that the third guide 250may comprise four channels 236 each comprising an inner ridge 237configured to engage the second plurality of control links 240, whilepermitting passage of the third plurality of control links 260 throughthe four channels 236, as described in further detail herein However, itwill be understood by one having skill in the art that, while theillustrated embodiment shows the guides including eight channels, theguide can be modified to include more or less channels depending on thesituation. For example, with reference to FIG. 14, the third guide 350of the insertion device 300 may comprise four channels each configuredto engage a respective control link of the second plurality of controllinks 340 and/or receive a respective control link of the thirdplurality of control links 360.

Referring to FIG. 9, the tool interface 270 can include one or morechannels 276 configured to receive and/or engage with one or more of thethird plurality of control links 260. The channels 276 may be formed toinclude an opening having a width sized and shape to correspond with acontrol link of the third plurality of control links 260, such that therespective control link is permitted to pass through and/or engage thetool interface 270. One or more of the channels 276, in some instances,can include an engagement portion (e.g., a ridge 277) configured toreduce a width of the opening and to facilitate engagement of the toolinterface 270 with a control link.

The one or more channels 276 of the tool interface 270 can be disposedat locations aligned with one or more channels 236 of an adjacent guide(e.g., the third guide 250 or an intermediate guide 290) to receive andengage a distal end of the third plurality of control links 260.

The tool interface 270 can engage one or more surgical instruments. Forexample, the one or more instruments can include dexterous tools forperforming a surgical procedure. The tool may include one or more ofgrippers, needle drivers, staplers, dissectors, cutters, hooks,graspers, scissors, coagulators, irrigators, and/or suction devices.Other tool arrangements could alternatively be employed. For example,the tool may alternatively be a cauterizing device, a suction device, anirrigation device, an illumination device, a retraction device or agrasping device.

Referring back to FIG. 5, in the embodiment shown, the insertion device200 includes several intermediate guides 290 positioned between each ofthe first guide 210, the second guide 230, the third guide 250, and thetool interface 270 with each of the plurality of control links 220, 240,260 passing through and/or engaging one or more of the guides 210, 230,250 and the tool interface 270. The engagement of the one or controllinks to individual guides can advantageously control tilting or panningof the individual guides and the articulation section 204. Theintermediate guides 290 can advantageously enable the articulationsection 204 to have pitch and yaw bend components sufficient to define acontinuous or substantially continuous arc extending through up to 90degrees. For example, the pulling and/or pushing of one or more of thefirst plurality of control links 220 connected to the second guide 230can control tilting of at least a portion of the articulation section204. Thus, in some instances, the second guide 230 can be positioned inan orientation in any direction relative to an axis of the first guide210 up to an angle of about 90 degrees off the axis of the first guide210. By way of another example, the pulling and/or pushing of one ormore of the third plurality of control links 260 connected to the toolinterface 270 can control tilting up/down of at least a portion of thearticulation section 204 (e.g., a tool engaged with the tool interface270). In some instances, the tool interface 270 can be positioned in anorientation in any direction relative to an axis of the third guide 250up to an angle of about 90 degrees off the axis of the third guide 250.

As stated herein, it will be understood that, while the abovedescription references the insertion device 200 of FIGS. 2-13, anyfeature, structure, material, step, or component of any embodimentdescribed and/or illustrated herein can be used with or instead of anyother feature, structure, material, step, or component of any embodimentof the insertion device 300 shown in FIGS. 14-20.

Control Links

As described herein, at least a portion of the articulation section 204of the insertion device 200 can articulate to permit positioning of asurgical tool at the site of interest. The insertion device 200 caninclude one or more plurality of control links 220, 240, 260 configuredto control movement of various portions of the articulation section 204.In some cases, the first plurality of control links 220 can controlpitch/tilt (up/down movement) and/or yaw/pan (left/right movement) ofthe second guide 230. The third plurality of control links 260 cancontrol pitch/tilt (up/down movement) and/or yaw/pan (left/rightmovement) of the tool interface 270. The second plurality of controllinks 240 can control movement of the first guide 210 and the thirdguide 250 by maintaining the position of the third guide 250 ingenerally a same or similar orientation as the first guide 210.

The second plurality of control links 240 can maintain the third guide250 in generally a same or similar orientation as the first guide 210even as the first plurality of control links 220 and/or the thirdplurality of control links 260 are being actuated. In some instances,one or more of the second plurality of control links 240, beingconnected between the first guide 210 and the third guide 250, can beconfigured to keep the third guide 250 at the same orientation as thefirst guide 210 when the first plurality of control links 220 move thesecond guide 230 and/or when the third plurality of control links 260moves the tool interface 270.

With reference to FIG. 6, one or more of the first plurality of controllinks 220 can extend through a respective channel 236 of the first guide210. In the illustrated embodiment, the insertion device 200 includesfour first control links 220 each passing through a respective channel236. Each of the respective channels 236 receiving a control link of thefirst plurality of control links 220 can be positioned 90° along anouter perimeter of the base 232 of the first guide 210 relative toanother channel 236. However, it will be understood that the amount ofcontrol links 220 and/or the respective channels 236 may be increased ordecreased. Additionally, it will also be understood that the placementof the channels 236 may be altered. For example, the first guide 210 mayinclude four channels 236 positioned by 120°, 60°, 120°, and 60°relative to each other, respectively. By way of another example, theinsertion device may include three first control links, such that thefirst guide 210 comprises three channels positioned 120° relative to theother channels.

One or more of the third plurality of control links 260 can extendthrough a respective channel 236 of the first guide 210. In someinstances, the channel 236 receiving a control link of the thirdplurality of control links 260 can be different than a channel 236receiving a control link of the first plurality of control links 220. Inthe illustrated embodiment, the insertion device 200 includes four thirdcontrol links 260 each passing through a respective channel 236. Each ofthe respective channels 236 receiving a control link of the thirdplurality of control links 260 can be positioned 90° along an outerperimeter of the base 232 of the first guide 210 relative to anotherchannel 236. However, it will be understood that the amount of controllinks 260 and/or the respective channels 236 may be increased ordecreased. Additionally, it will also be understood that the placementof the channels 236 may be altered. For example, the first guide mayinclude four channels positioned by 120°, 60°, 120°, and 60° relative toeach other, respectively. By way of another example, the insertiondevice may include three third control links, such that the first guidecomprises three channels positioned 120° relative to the other channels.

One or more of the second plurality of control links 240 can engage witha respective channel 236 of the first guide 210. In some instances, thechannel 236 engaging a control link of the second plurality of controllinks 240 can be different than a channel 236 receiving a control linkof the first plurality of control links 220 but be the same as thechannel 236 receiving a control link of the third plurality of controllinks 260. In the illustrated embodiment, the insertion device 200includes four second control links 240 each engaging a respectivechannel 236. Each of the respective channels 236 engaging a control linkof the second plurality of control links 240 can be positioned 90° alongan outer perimeter of the base 232 of the first guide 210 relative toanother channel 236. However, it will be understood that the amount ofcontrol links 240 and/or the respective channels 236 may be increased ordecreased. Additionally, it will also be understood that the placementof the channels 236 may be altered. For example, the first guide mayinclude four channels positioned by 120°, 60°, 120°, and 60° relative toeach other, respectively. By way of another example, the insertiondevice may include three second control links, such that the first guidecomprises three channels positioned 120° relative to the other channels.

One or more of the second plurality of control links 240 can engage thefirst guide 210 and/or the third guide 250 (as described herein withreference to FIG. 8) through various methods. In some instances, withreference to FIG. 6, an end portion 242 of one or more of the secondplurality of control links 220 can be configured to engage at least aportion of a respective channel 236 (e.g., the ridge 237 of therespective channel 236) of the first guide 210 to engage the controllink 240 with the first guide 210. The control link 240 can beconfigured to engage the channel 236 by a screw fit, snap fit,interference fit, or otherwise to inhibit disengagement of the controllink 240 from an engaged configuration with the first guide 210.

With reference to FIG. 6, as one or more of the third plurality ofcontrol links 260 passes through one or more respective channels 236 ofthe first guide 210 that are engaged with one or more of the secondcontrol links 240, one or more of the plurality second control links 240are configured to at least partially overlap and/or be coaxially alignedwith at least a portion of a respective one or more of the plurality ofthird control links 260. For example, one of the third plurality ofcontrol links 260 can be configured to be at least partially nestedwithin one of the second plurality of control links 240, as described infurther detail herein.

It will be understood by one having skill in the art that, although theillustrated embodiment shows one of a third control link 260 at leastpartially positioned within one of a second control link 240, anynesting combination between one or more of any of the plurality ofcontrol links 220, 240, 260 may occur. For example, one of the secondcontrol links 240 may be positioned within one of the first controllinks 220 or one of the third control links 260. In some instances, notall links of the third plurality of control links 260 may be nested onor within all the second plurality of control links 240.

The overlapping and/or alignment of individual control links (e.g., athird control link 260 and a second control link 240, as illustrated inFIG. 5) advantageously reduces the amount of links positioned along anoutside perimeter of the base of a guide. For example, as illustrated inFIG. 6, nesting of each of the second plurality of control links 240with each of the third plurality of control links 260 reduces the numberof channels and control links positioned along the outer perimeter ofthe base 232 of the first guide 210 from twelve to eight. This reductioncan advantageously decrease any unintentional interaction between theplurality of control links 220, 240, 260 when one or more of the controllinks 220, 240, 260 are actuated. In some instances, this reduction canincrease the flexibility and/or provide better resolution of curvaturewithin the articulated section 204 of the insertion device 200.

With reference to FIG. 7, one or more of the first plurality of controllinks 220 can engage a respective channel 236 of the second guide 230.As described above, while the illustrated embodiment shows that theinsertion device 200 includes four first control links 220 each engaginga respective channel 236, it will be understood that the amount ofcontrol links 220 and/or the respective channels 236 may be increased ordecreased and/or that the placement of the channels 236 may be altered.

One or more of the second plurality of control links 240 can extendthrough a respective channel 236 of the second guide 230. In someinstances, the channel 236 engaging a control link of the secondplurality of control links 240 can be different than a channel 236receiving a control link of the first plurality of control links 220 butbe the same as the channel 236 receiving a control link of the thirdplurality of control links 260 when the second plurality of controllinks 240 are in a nested configuration with the third plurality ofcontrol links 260. As described above, while the illustrated embodimentshows that the insertion device 200 includes four second control links240 each engaging a respective channel 236, it will be understood thatthe amount of control links 240 and/or the respective channels 236 maybe increased or decreased and/or that the placement of the channels 236may be altered.

With reference to FIG. 8, one or more of the second plurality of controllinks 240 can engage a respective channel 236 of the third guide 250. Asdescribed above, while the illustrated embodiment shows that theinsertion device 200 includes four second control links 240 eachengaging a respective channel 236, it will be understood that the amountof control links 240 and/or the respective channels 236 may be increasedor decreased and/or that the placement of the channels 236 may bealtered.

One or more of the third plurality of control links 260 can extendthrough a respective channel 236 of the third guide 250. In someinstances, the channel 236 receiving a control link of the thirdplurality of control links 260 can be be the same as the channel 236engaging a control link of the second plurality of control links 240when the second plurality of control links 240 are in a nestedconfiguration with the third plurality of control links 260. Asdescribed above, while the illustrated embodiment shows that theinsertion device 200 includes four third control links 260 each passingthrough a respective channel 236, it will be understood that the amountof control links 260 and/or the respective channels 236 may be increasedor decreased and/or that the placement of the channels 236 may bealtered.

With reference to FIG. 9, one or more of the third plurality of controllinks 260 can engage a respective channel 276 of the tool interface 270.As described above, while the illustrated embodiment shows that theinsertion device 200 includes four third control links 260 each engaginga respective channel 276, it will be understood that the amount ofcontrol links 260 and/or the respective channels 276 may be increased ordecreased and/or that the placement of the channels 276 may be altered.

One or more of the pluralities of control links 220, 240, 260 canengage, as described herein, at least one of the first guide 210, thesecond guide 230, the third guide 250, and/or the tool interface 270through various methods. In some instances, with reference again to FIG.7, a distal end portion of one or more of the first plurality of controllinks 220 may include at least one guide connection feature 222. Theguide connection feature 222 can protrude from an outer surface of thecontrol link 220. The guide connection feature 222 can be configured toengage the ridge 237 of the respective channel 236 within the secondguide 230 to engage the control link 220 with the second guide 230. Theguide connection feature 222 can include a peg, a barb, a screw, orother protruding structure, configured to engage the channel 236 by ascrew fit, snap fit, interference fit, or otherwise. Each guideconnection feature 222 can be configured to inhibit disengagement of thecontrol link 220 from an engaged configuration with the second guide236. In some embodiments, the guide connection feature 222 is a flangeextending radially outward from an end of the control link 220. In someembodiments, the guide connection feature 222 can include an externalconcave structure that can receive a portion of the ridge 237, asdiscussed herein. The external concave structure can include acircumferential groove that extends around the control link 222. Thecircumferential groove can extend entirely around the control link 220,in one embodiment. It will be understood that, while the guideconnection feature 222 is discussed with reference to the firstplurality of control links 220 and FIG. 7, each of the third pluralityof control links 260 can include a guide connection feature 262configured to engage at least the tool interface 270 in the same orgenerally similar manner as described herein with reference to the guideconnection feature 222.

As stated herein, it will be understood that, while the abovedescription references the insertion device 200 of FIGS. 2-13, anyfeature, structure, material, step, or component of any embodimentdescribed and/or illustrated herein can be used with or instead of anyother feature, structure, material, step, or component of any embodimentof the insertion device 300 shown in FIGS. 14-20.

One or more of the first and/or third pluralities of control links 220,260 may include a single nitinol wire. In some instances, the nitinolwire can be capable of tension or compression forces without permanentdeformation and capable of experiencing up to about 4% strain. Nitinolis an alloy of nickel and titanium having shape memory and superelasticity and its ability to support both tension and compressionallows the links to be selectively pushed or pulled with similar forceswithout permanent deformation, which provides for precise control of thecontrol links, actuation redundancy and increased structural stiffness.Accordingly, each of the first and/or second pluralities of controllinks 220, 260 are configured to be pushed and/or pulled to move therespective guides the links are engaged with and to achieve a full rangeof movement of the tool interface 270 relative to the first guide 210.

One or more of the first and/or third pluralities of control links 220,260 can include a wire, cable, or the like with elasticity that cansupport at least one of tension or compression without permanentdeformation. One or more of the control links 220, 260 can be connectedto the one or more guides, as described herein. Movement, such aspulling and/or pushing, of the one or more control links 220, 260 cancause adjustment of the spatial orientation of the one or more guides(e.g., the first guide 210, the second guide 230, and/or the third guide250) and/or the tool interface 270 and, as a result, one or moreportions of the articulation section 204.

In some instances, one or more of the first, second, and/or thirdpluralities of control links 220, 240, 260 can include a hollow interiorconfigured to receive at least a portion of another control link. Withreference to FIG. 5-8, one or more of the second plurality of controllinks 240 can include a hollow interior configured to receive at least aportion of a respective control link of the third plurality of controllinks 260. The second control link 240 comprising a hollow interiorpermits the nesting (e.g., overlapping) configuration, as describedherein. The hollow interior, in some embodiments, can be formed by theone or more second plurality of control links 240 being formed as a tubeor as a coil. The coil can define a hollow interior configured (e.g.,sized and shaped) to receive another control therethrough.

In some instances, the coil can be capable of tension or compressionforces without permanent deformation. The coil's ability to support bothtension and compression allows the links 240 to be selectively pushedand/or pulled to facilitate maintaining the first guide 210 and thethird guide 250 in a generally same or similar orientation. For example,the material properties of a coil of one or more of the second controllink 240 can be selected such that actuation of the one or more controllinks 240 causes at least one of the first guide 210, the second guide230, the third guide 250, and/or the tool interface 270 to beselectively moved into any of a plurality of orientations defining asubstantially continuous curve. As described herein, the coil can besufficiently tight including a high compression rigidity and a hightension spring force. The coil's ability to support both tension andcompression allows the second control link 240 to selectively move atleast one of the guides and/or the tool interface and define asubstantially continuous curve along at least a portion of thearticulation section 204. Accordingly, each of the second plurality ofcontrol links 240 are configured to be pushed and/or pulled to move therespective guides the links are engaged with and to achieve a full rangeof movement of the tool interface 270 relative to the first guide 210.In other instances, where the coil does not have a sufficiently hightension spring force, the coil may only support compression andtherefore the respective control link would be selectively pushable tocause movement of the guides to define a substantially continuous curve.

One or more of the first and/or third pluralities of control links 220,260 can include a wire, cable, or the like with elasticity that cansupport at least one of tension or compression without permanentdeformation. One or more of the control links 220, 260 can be connectedto the one or more guides, as described herein. Movement, such aspulling and/or pushing, of the one or more first and/or thirdpluralities of control links 220, 260 can cause adjustment of thespatial orientation of the one or more guides (e.g., the first guide210, the second guide 230, and/or the third guide 250) and/or the toolinterface 270, and as a result of a coil's elasticity, each of thesecond plurality of control links 240 can be configured to adjustaccordingly.

As described herein, one or more actuators can pull and/or push the oneor more control links 220, 260, for example, via rotation in firstand/or second directions. Pulling a link 220, 260 can cause shorteningits length, while pushing the link can cause lengthening the link (suchas, returning the link substantially to its initial length).

As stated herein, it will be understood that, while FIGS. 2-13illustrate that each of the second plurality of control links 240 isconfigured to receive a respective control link of a third plurality ofcontrol links 260, any one of the first and/or second pluralities ofcontrol links 220, 260 can be modified to incorporate any feature,structure, material, step, or component of any embodiment describedand/or illustrated herein to be configured to receive any one of theother first, second, and/or third pluralities of control links 220, 240,260.

In some embodiments, at least one of the first and/or third pluralitiesof control links can include an internal control link and an externalcontrol link. FIG. 15 shows that, in certain embodiments, at least oneof the first plurality of control links 320 may comprise an externalcontrol link 327 (e.g., an outer coil) and an internal control link 328(e.g., inner wire). The external control link 327 can be similar to thecoil as described with reference to the second plurality of controllinks 240 of the insertion device 200. The external control link 327 caninclude a hollow interior configured to receive at least a portion ofthe internal control link 328 such that the hollow interior permits theexternal control link 327 to overlap at least a portion of the internalcontrol link 328. The internal control link 328 can support tensionwithout permanent deformation. One or more of the control links 220, 260can be connected to the one or more guides, as described herein.

One or more of the external control links 327, in some instances, caninclude a flexible tube. In some instances, the flexible tube can becapable of tension and/or compression forces without permanentdeformation. The flexible tube's ability to support both tension andcompression allows the external control links 327 to be selectivelypushed and/or pulled to facilitate with similar forces without permanentdeformation, which provides for precise control of the control links,actuation redundancy and increased structural stiffness.

The internal control link's 328 ability to support tension, along withthe external control link 327 ability to support compression, allows thelinks 320 to be selectively pulled via the internal control link 328(e.g., the wire) (such that the external control link 327 becomescompressed) and/or pushed via the external control link 327 (e.g., theflexible tube and/or the coil) (as tension is released on the internalcontrol link 328), which provides for precise control of the controllinks, actuation redundancy and increased structural stiffness.Movement, such as pulling and/or pushing, of the one or more controllinks 320 cause adjustment of the spatial orientation of the one or moreguides (e.g., the first guide 310, the second guide 330, and/or thethird guide 350) and/or the tool interface 370 and, as a result, one ormore portions of the articulation section 304.

In some instances, the internal control link 328 can include a braidedwire, which can simply manufacturability of the internal control link328 and decrease manufacturing costs with respect to a device includinga single nitinol wire. It will be understood that, while the abovediscussion references the first plurality of control links 320 as shownin FIG. 15, any one of the second and/or third pluralities of controllinks 340, 360 can be modified to incorporate any feature, structure,material, step, or component of any embodiment described and/orillustrated herein. For example, as illustrated in FIG. 16, the thirdplurality of control links 360 can include an external control link 367and an internal control link 368 that are generally the same or similarto the first plurality of control links 320. Accordingly, each of thefirst and/or second pluralities of control links 320, 360 can beconfigured to be pushed via the external control link 327, 367 and/orpulled via the internal control link 328, 368 to move the respectiveguides the links are engaged with and to achieve a full range ofmovement of the tool interface 370 relative to the first guide 310. Forexample, pulling the internal control link 328, 368 can cause the toolinterface 370 to change position and to compress the external controllink 327, 367. As another example, an actuator moving to compress orpush the external control link 327, 367 can cause the tool interface 370to change position and to pull the internal control link 328, 368. Sucharrangement can be an alternative to pushing/pulling a nitinol wire.

As described herein, one or more actuators can pull the one or morecontrol links 220, 260, for example, via rotation in first and/or seconddirections. In some instances where at least one of the first and/orthird pluralities of control links 320, 360 comprises an externalcontrol link 327, 367 and an internal control link 328, 368, theactuator may be configured to pull on the internal control link 328, 368causing a compression of the external control link 327, 367. Uponrelease of the tension caused by the actuator pulling on the internalcontrol link 328, 368, the external control link 327, 367 can apply arestoring force to “push” a corresponding guide to which the externalcontrol link 327, 367 is attached, thereby causing the internal controllink 328, 368 to be pulled and, thus, extended and returning theinternal control link 328, 368 substantially to its initial length. Insome instances, such as when the external control link 327, 367comprises a flexible tube, the actuator may be configured to push on theexternal control link 327, 367 causing extension of the internal controllink 328, 368. The ability to selectively actuate one or more of theexternal control link 327, 367 and/or the internal control link 328, 368advantageously allows the user the ability to more directly controlindividual movement of the various components of the insertion device200. For example, at least with reference to the third plurality ofcontrol links 360, the ability to selectively push the external controllink (e.g., coil or flexible tube) and pull the internal control link(e.g., a braided wire) can allow a user to more efficiently andconsistently manipulate the tool interface 370 and/or a correspondingsurgical tool during use.

One or more of the external control links 327, 367 and/or the internalcontrol link 328, 368 (e.g., a coil and a cable) can be configured tocomprise a sufficient tension between the respective links such that thelinks contain a sufficient amount of rigidity to prevent at least aportion of the articulation section 204 from drooping or sagging as theinsertion device 200 is in use. Rigidity can help to reduce the sizeand/or number of guides while still inhibiting drooping or sagging asthe insertion device 200. For example, one or more of the intermediateguides may not be included if a sufficient amount of tension existsbetween one or more of the external control links 327, 367 and/or theinternal control link 328, 368 (e.g., a coil and a cable). A reductionin the size and/or number of guides may improve the degrees offlexibility and movement of the various components of the insertiondevice 200.

Similar to other embodiments described herein, one or more of theexternal control link 327, 367 can engage the actuator through variousmethods. In some instances, with reference to FIG. 19, an end portion329 of one or more of the external control link 327 of a control link ofa first plurality of control links 320 can be configured to engage atleast a portion of a respective channel 436 of an actuator assembly 430to engage the external control link 327 with the actuator assembly 430.The external control link 327 can be configured to engage the channel436 by a screw fit, snap fit, interference fit, or otherwise to inhibitdisengagement of the external control link 327 from an engagedconfiguration with the actuator assembly 430. The actuator assemblyincludes an actuator 432. In some cases, the actuator assembly 430 canbe similar to the actuator housing 142 and the actuator 432 can besimilar to one of the actuators 130 illustrated in FIG. 1B.

Additional details of controlling one or more of the tilt or pan of theinsertion device 200 are similar to those described in U.S. PatentPublication No. 2016/0143633 and U.S. Pat. No. 9,629,688, which areassigned to the assignee of the present application and the disclosureof each of which is incorporated by reference in its entirety.

As stated herein, it will be understood that, while the abovedescription references the insertion device 200 of FIGS. 2-13, anyfeature, structure, material, step, or component of any embodimentdescribed and/or illustrated herein can be used with or instead of anyother feature, structure, material, step, or component of any embodimentof the insertion device 300 shown in FIGS. 14-20.

Support Cover

The insertion device 200, in some embodiments as illustrated FIGS. 2-4,can include one or more support covers. At least a portion of thearticulation section 204 can be overlaid and/or enclosed by a supportcover. The support cover can include one or more of an external sheath206 and a coil 208. In some instances, the insertion device 200 caninclude a support cover comprising both an external sheath 206 and acoil 208. The external sheath 206 may be placed in an overlappingposition with the coil 208 along at least a portion of the articulationsection 204.

The one or more support covers 206, 208 can be flexible or substantiallyflexible such as to not inhibit movement of one or more portions of thearticulation section 204. One or more of support covers 206, 208, insome instances, can contain a sufficient amount of rigidity to preventat least the tool interface 270 from drooping or sagging as theinsertion device 200 is in use. Drooping or sagging can undesirably leadto at least a decrease in the accuracy when navigating the toolinterface 270 within a part of the site of interest or inadvertentcontact with tissue near or outside the site of interest. Rigidity canhelp maintain orientation of at least the third guide 250 in sameorientation of the first guide 210. In some instances, the one or moresupport covers can be configured to inhibit displacement of at least oneof the first, second, and third pluralities of control links from arespective channel(s) of the first guide, the second guide, the thirdguide, and/or the tool interface. The one or more support covers can beconfigured to maintain at least one of the first, second, and thirdpluralities of control links such that, in some instances, the sizeand/or number of guides may be reduced while still inhibitingunintentional displacement of at least one of the first, second, andthird pluralities of control links from a respective channel(s). Forexample, one or more of the intermediate guides may not be included ifthe insertion device includes one or more support covers. A reduction inthe size and/or number of guides may improve the degrees of flexibilityand movement of the various components of the insertion device 200.

The one or more support covers can be configured to overlay thearticulation section 204 to prevent ingress of fluids and/or solidswithin the articulation section 204. One or more of the support covers206, 208, in some instances can comprise a fluid impermeable materialconfigured to inhibit the passage of fluid through the support cover260, 208. Ingress of fluids and/or within the articulation section 204may negatively impact the use of the insertion device 200 by alteringthe degrees of flexibility and movement of the various components of theinsertion device 200. For example, in some instances, the externalsheath 206 may comprise a plastic or other fluid impermeable materialconfigured to inhibit the passage of fluid while maintaining a degree offlexibility such as to not inhibit movement of the articulation section204.

It will be understood that, while the one or more support covers 206,208 are discussed with reference to the insertion device 200 of FIGS.2-13, the one or more support covers 206, 208 can be included in thesame or generally similar manner as described herein with reference tothe insertion device 300 of FIGS. 14-20.

Other Variations

Those skilled in the art will appreciate that, in some embodiments,additional components and/or steps can be utilized, and disclosedcomponents and/or steps can be combined or omitted. For example,although some embodiments are described in connection with a roboticsurgery system, the disclosure is not so limited. Systems, devices, andmethods described herein can be applicable to medical procedures ingeneral, among other uses. As another example, certain components can beillustrated and/or described as being circular or cylindrical. In someimplementations, the components can be additionally or alternativelyinclude non-circular portions, such as portions having straight lines.As yet another example, any of the actuators described herein caninclude one or more motors, such as electrical motors.

The foregoing description details certain embodiments of the systems,devices, and methods disclosed herein. It will be appreciated, however,that no matter how detailed the foregoing appears in text, the systems,devices, and methods can be practiced in many ways. The use ofparticular terminology when describing certain features or aspects ofthe disclosure should not be taken to imply that the terminology isbeing redefined herein to be restricted to including any specificcharacteristics of the features or aspects of the technology with whichthat terminology is associated.

It will be appreciated by those skilled in the art that variousmodifications and changes can be made without departing from the scopeof the described technology. Such modifications and changes are intendedto fall within the scope of the embodiments. It will also be appreciatedby those of skill in the art that parts included in one embodiment areinterchangeable with other embodiments; one or more parts from adepicted embodiment can be included with other depicted embodiments inany combination. For example, any of the various components describedherein and/or depicted in the figures can be combined, interchanged, orexcluded from other embodiments.

With respect to the use of substantially any plural and/or singularterms herein, those having skill in the art can translate from theplural to the singular and/or from the singular to the plural as isappropriate to the context and/or application. The varioussingular/plural permutations can be expressly set forth herein for sakeof clarity.

Directional terms used herein (for example, top, bottom, side, up, down,inward, outward, etc.) are generally used with reference to theorientation or perspective shown in the figures and are not intended tobe limiting. For example, positioning “above” described herein can referto positioning below or on one of sides. Thus, features described asbeing “above” may be included below, on one of sides, or the like.

It will be understood by those within the art that, in general, termsused herein are generally intended as “open” terms (for example, theterm “including” should be interpreted as “including but not limitedto,” the term “having” should be interpreted as “having at least,” theterm “includes” should be interpreted as “includes but is not limitedto,” etc.). It will be further understood by those within the art thatif a specific number of an introduced claim recitation is intended, suchan intent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims can contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to embodiments containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (for example, “a” and/or “an” should typically be interpreted tomean “at least one” or “one or more”); the same holds true for the useof definite articles used to introduce claim recitations. In addition,even if a specific number of an introduced claim recitation isexplicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (for example, the bare recitation of “two recitations,” withoutother modifiers, typically means at least two recitations, or two ormore recitations).

The term “comprising” as used herein is synonymous with “including,”“containing,” or “characterized by,” and is inclusive or open-ended anddoes not exclude additional, unrecited elements or method steps.

Conditional language, such as “can,” “could,” “might,” or “may,” unlessspecifically stated otherwise, or otherwise understood within thecontext as used, is generally intended to convey that certainembodiments include, while other embodiments do not include, certainfeatures, elements, and/or steps. Thus, such conditional language is notgenerally intended to imply that features, elements, and/or steps are inany way required for one or more embodiments or that one or moreembodiments necessarily include logic for deciding, with or without userinput or prompting, whether these features, elements, and/or steps areincluded or are to be performed in any particular embodiment.

Language of degree used herein, such as the terms “approximately,”“about,” “generally,” and “substantially” as used herein represent avalue, amount, or characteristic close to the stated value, amount, orcharacteristic that still performs a desired function and/or achieves adesired result. For example, the terms “approximately”, “about”,“generally,” and “substantially” may refer to an amount that is withinless than 10% of, within less than 5% of, within less than 1% of, withinless than 0.1% of, and/or within less than 0.01% of the stated amount.

It will be further understood by those within the art that anydisjunctive word and/or phrase presenting two or more alternative terms,whether in the description, claims, or drawings, can be understood tocontemplate the possibilities of including one of the terms, either ofthe terms, or both terms. For example, the phrase “A or B” will beunderstood to include the possibilities of “A” or “B” or “A and B.”Further, the term “each,” as used herein, in addition to having itsordinary meaning, can mean any subset of a set of elements to which theterm “each” is applied.

Conjunctive language such as the phrase “at least one of X, Y, and Z,”unless specifically stated otherwise, is otherwise understood with thecontext as used in general to convey that an item, term, etc. may beeither X, Y, or Z. Thus, such conjunctive language is not generallyintended to imply that certain embodiments require the presence of atleast one of X, at least one of Y, and at least one of Z.

The above description discloses embodiments of systems, apparatuses,devices, methods, and materials of the present disclosure. Thisdisclosure is susceptible to modifications in the components, parts,elements, steps, and materials, as well as alterations in thefabrication methods and equipment. Such modifications will becomeapparent to those skilled in the art from a consideration of thisdisclosure or practice of the disclosure. Consequently, it is notintended that the disclosure be limited to the specific embodimentsdisclosed herein, but that it cover all modifications and alternativescoming within the scope and spirit of the subject matter embodied in thefollowing claims.

What is claimed is:
 1. An insertion device for a robotic surgeryapparatus, the insertion device comprising: a first guide comprising afirst plurality of channels arranged in an annular array, wherein eachchannel of the first plurality of channels is open in a radially outwarddirection; a second guide comprising a second plurality of channelsarranged in an annular array, wherein each channel of the secondplurality of channels is open in a radially outward direction; a thirdguide comprising a third plurality of channels arranged in an annulararray, wherein each channel of the third plurality of channels is openin a radially outward direction, wherein the first plurality of guidechannels, the second plurality of guide channels and the third pluralityof guide channels are axially aligned with one another; a tool interfaceconfigured to engage a surgical tool configured to perform roboticsurgery; a first plurality of control links each comprising a firstdistal end portion including a guide connection feature having: a firstprotruding structure located distal of and in contact with the secondguide; and a second protruding structure located proximal of and incontact with the second guide, wherein the first and second protrudingstructures directly engage the second guide to transmit at least one ofa push or pull force thereto, each of the first plurality of controllinks extending through a respective channel of the first plurality ofchannels of the first guide; a second plurality of control links eachcomprising: a first end portion that engages the first guide, and asecond end portion that engages the third guide, wherein each of thesecond plurality of control links extends through a respective channelof the second plurality of channels of the second guide; and a thirdplurality of control links each comprising a first distal end portionincluding a guide connection feature having: a first protrudingstructure located distal of and in contact with the tool interface; anda second protruding structure located proximal of and in contact withthe tool interface, wherein the first and second protruding structuresdirectly engage the tool interface to transmit the at least one push orpull force thereto, each of the third plurality of control linksextending through respective channels of the third plurality of channelsof the third guide and further extending through the respective channelsof the second plurality of channels of the second guide, each of thethird plurality of control links including a portion that passes througha respective second control link of the second plurality of controllinks, wherein one or more of the first plurality of control links areconfigured to be actuated to cause the first guide, the second guide,and the third guide to assume positions that selectively define asubstantially continuous curve, wherein one or more of the secondplurality of control links are configured to cause the third guide tomaintain an orientation generally the same as the first guide when anyof the first plurality of control links and third plurality of controllinks is actuated, and wherein one or more of the third plurality ofcontrol links are configured to be actuated to cause the tool interfaceto be selectively moved into any of a plurality of orientations defininga substantially continuous curve from the third guide to the toolinterface.
 2. The insertion device of claim 1 further comprising asupport cover configured to inhibit at least one of: displacement ofeach of the first plurality of control links from the respective channelof the first plurality of channels of the first guide, displacement ofeach of the second plurality of control links from the respectivechannel of the second plurality of channels of the second guide, ordisplacement of each of the third plurality of control links from therespective channel of the second plurality of channels of the secondguide.
 3. The insertion device of claim 2, wherein the support covercomprises an external sheath.
 4. The insertion device of claim 2,wherein the support cover comprises a coil.
 5. The insertion device ofclaim 2 wherein the support cover comprises an external sheath and acoil, and wherein the external sheath covers the coil.
 6. The insertiondevice of claim 1, wherein each of the first plurality of channels ofthe first guide are sized to receive a respective control link of anyone of the first plurality of control links, the second plurality ofcontrol links, or the third plurality of control links.
 7. The insertiondevice of claim 1, wherein each of the second plurality of channels ofthe second guide are sized to receive a respective control link of anyone of the first plurality of control links or the second plurality ofcontrol links.
 8. The insertion device of claim 1, wherein each of thethird plurality of channels of the third guide are sized to receive arespective control link of any one of the second plurality of controllinks and the third plurality of control links.
 9. The insertion deviceof claim 1, wherein each of the second plurality of control linkscomprises a hollow interior portion through which the portion of arespective third control link passes.
 10. The insertion device of claim1, wherein each of the first plurality of control links comprises anexternal control link defining an internal pathway and an internalcontrol link, and wherein at least a portion of each of the internalcontrol links pass through a respective internal pathway.
 11. Theinsertion device of claim 1, wherein each of the third plurality ofcontrol links comprises an external control link defining an internalpathway and an internal control link, and wherein at least a portion ofeach of the internal control links pass through a respective internalpathway.
 12. The insertion device of claim 1 further comprising at leastone first intermediate guide positioned between the first guide and thesecond guide.
 13. The insertion device of claim 12, wherein the at leastone first intermediate guide comprises a first guide and a second guide,wherein the first guide of the at least one first intermediate guideengages the first guide, and wherein the second guide of the at leastone first intermediate guide engages the second guide.
 14. The insertiondevice of claim 1 further comprising at least one second intermediateguide positioned between the second guide and the third guide.
 15. Theinsertion device of claim 14, wherein the at least one secondintermediate guide comprises a first guide and a second guide, whereinthe first guide of the at least one second intermediate guide engagesthe second guide, and wherein the second guide of the at least onesecond intermediate guide engages the third guide.
 16. The insertiondevice of claim 1 further comprising at least one third intermediateguide positioned between the third guide and the tool interface.
 17. Theinsertion device of claim 16, wherein the at least one thirdintermediate guide comprises a first guide and a second guide, whereinthe first guide of the at least one third intermediate guide engages thethird guide, and wherein the second guide of the at least one thirdintermediate guide engages the tool interface.
 18. The insertion deviceof claim 1, wherein each of the first plurality of control links aredisposed in a parallel spaced apart relation through the respectivefirst channel of the first plurality of channels of the first guide,wherein each of the second plurality of control links are disposed in aparallel spaced apart relation through the respective second channel ofthe second plurality of channels of the second guide, and wherein eachof the third plurality of control links are disposed in a parallelspaced apart relation through a respective first channel of the firstplurality of channels of the first guide, through the respective secondchannel of the second plurality of channels of the second guide, andthrough the respective third channel of the third plurality of channelsof the third guide.
 19. An insertion device for a robotic surgeryapparatus, the insertion device comprising: a first guide comprising afirst plurality of channels; a second guide comprising a secondplurality of channels; a third guide comprising a third plurality ofchannels; an instrument interface configured to engage a surgicalinstrument; a first plurality of control links comprising a plurality ofdistal first ends including a plurality of respective guide connectionfeatures having a first protruding structure located distal of thesecond guide and a second protruding structure located proximal of thesecond guide, wherein the second guide is disposed immediately betweenthe first and second protruding structures of the first plurality ofcontrol links to transmit at least one of a push or pull force thereto,each of the first plurality of control links passing through arespective channel of the first plurality of channels of the firstguide; a second plurality of control links comprising a plurality offirst ends that engage the first guide and a plurality of second endsthat engage the third guide, wherein each of the second plurality ofcontrol links passes through a respective channel of the secondplurality of channels of the second guide; and a third plurality ofcontrol links comprising a plurality of distal first ends including aplurality of respective guide connection features having a firstprotruding structure located distal of the instrument interface and asecond protruding structure located proximal of the instrumentinterface, wherein the instrument interface is disposed immediatelybetween the first and second protruding structures of the thirdplurality of control links to transmit the at least one push or pullforce thereto, each of the third plurality of control links passingthrough a respective channel of the third plurality of channels of thethird guide and further passing through the respective channel of thesecond plurality of channels of the second guide, at least one controllink of the third plurality of control links being coaxially alignedwith a respective second control link of the second plurality of controllinks, wherein one or more of the plurality of first, second, or thirdcontrol links are configured to be actuated to adjust spatial positionof the instrument interface to facilitate repositioning of the surgicalinstrument.
 20. The insertion device of claim 19 further comprising asupport cover configured to inhibit at least one of: displacement ofeach of the first plurality of control links from the respective firstchannel of the first plurality of channels of the first guide,displacement of each of the second plurality of control links from therespective second channel of the second plurality of channels of thesecond guide, or displacement of each of the third plurality of controllinks from the respective second channel of the second plurality ofchannels of the second guide.
 21. The insertion device of claim 20,wherein the support cover comprises any one of an external sheath or acoil.
 22. The insertion device of claim 20 wherein the support covercomprises an external sheath and a coil, and wherein the external sheathcovers the coil.
 23. The insertion device of claim 19, wherein each ofthe first plurality of channels are sized to receive a respectivecontrol link of any one of the first plurality of control links, thesecond plurality of control links, or the third plurality of controllinks.
 24. The insertion device of claim 19, wherein each of the secondplurality of channels are sized to receive a respective control link ofany one of the first plurality of control links or the second pluralityof control links.
 25. The insertion device of claim 19, wherein each ofthe third plurality of channels are sized to receive a respectivecontrol link of any one of the second plurality of control links and thethird plurality of control links.
 26. The insertion device of claim 19,wherein the respective second control link of the second plurality ofcontrol links comprises a hollow interior portion through which aportion of the at least one control link of the third plurality ofcontrol links passes.
 27. The insertion device of claim 19, wherein eachof the first plurality of control links comprises an external controllink defining an internal pathway and an internal control link, andwherein at least a portion of each of the internal control links passthrough a respective internal pathway.
 28. The insertion device of claim19, wherein each of the third plurality of control links comprises anexternal control link defining an internal pathway and an internalcontrol link, and wherein at least a portion of each of the internalcontrol links pass through a respective internal pathway.
 29. Theinsertion device of claim 19 further comprising: at least one firstintermediate guide positioned between the first guide and the secondguide; at least one second intermediate guide positioned between thesecond guide and the third guide; and at least one third intermediateguide positioned between the third guide and the instrument interface.